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The Elderly in Our Midst.

A few weeks ago, I
had to have some dental work done. The procedure was simple enough; it involved
putting a bridge across a few teeth. The
process included removing the remnants of an old tooth, putting a temporary
crown over the gap, and after about two weeks, put in a permanent crown in that
space. The temporary crown was not
gummed in too fast, as it will need to be removed soon, and a couple of days
after it was inserted it became loose. No big deal, really, as long as it did
not fall off. But the experience was quite a revelation! It was a long crown --- covered about 4 or 5
teeth, and every time I spoke, or ate something, I could feel it shake. It was
so disconcerting, that eating became a worrisome activity. I also tried to avoid speaking too much, and
those of my readers who know me will probably appreciate what an ordeal
curtailing speaking was for me. During those few days, the last few months of
my father’s life kept coming back to me. He was in his 89th year,
with gradually failing health. One of the outcomes of ageing was that his
dentures started becoming loose --- a very common phenomenon with the elderly
as the jaw bone mass gradually shrinks.
Sometimes it would happen while he was in the middle of a conversation
with someone, sometimes while eating.
We, the family members took it in our stride. We sympathized with him. It was only now,
with my crown becoming loose, that I realize what he was going through! Only
now am I being able to empathize with
him!

This is what this
post is about --- the elderly in our midst. As the elders who have been the pillars
of my world are ageing, as some have left us forever, this is a thought that is
very much on my mind. As I watch the seniors in my family gradually change with
age, a lot of what I had studied in my gerontology classes take new meaning. Especially during the last two years of my
father’s life, I spent a lot of time reading about and analysing the ageing
body with him, as both of us tried to make sense of these changes. I am piecing
together some of my own understandings that came out of those readings and
discussions.

A book that we
discussed during that time was ‘Being Mortal’ by Atul Gawande. In his book Gawande,
himself a practicing surgeon, explores the processes of aging and its ultimate
outcome, dying. The book is an interesting read. The style is anecdotal, but based on research
and stories from his patients, family and a range of experts in the field. A
key premise of the book is that medical training teaches doctors to prolong
life. It is ill equipped to handle end of life situations. He says that most
medical professionals are “good at addressing specific, individual problems:
colon cancer, high blood pressure, arthritic knees. Give us a disease, and we
can do something about it. But give us an elderly woman with high blood
pressure, arthritic knees, and various other elements besides --- an elderly
woman at risk of losing the life she enjoys ---- and we hardly know what to do
and often only make matters worse”.

One of the experts
he talked to was Dr Felix Silverstone, a leading specialist
in Geriatrics in America for five decades. When Gawande met him, Dr Silverstone
was himself 87, still practicing, and adding his own personal age-related
experience to his research. “He was
trying to note the changes he experienced objectively, like the geriatrician
that he is. He noticed that his skin had dried out. His sense of smell was
diminished. His night vision had become poor, and he tired easily. He had begun
to lose teeth.”

As a person ages,
several things he or she took for granted starts to diminish. The most important are sight and hearing. Of the two, sight is easier to fix. Wearing
the right lenses makes the world a lot clearer. Hearing, on the other hand, is a much more difficult
ball game. A lot of the hearing aids are
merely amplifiers. They amplify
everything --- including the sound of the fan, the crowing of the crows, the
honking of a car. For most regular people, filtering out these extraneous sounds
become second nature. But with a senior person, re-learning to filter out these
outside, amplified, cacophonic noises is not very easy. Hence, many tend to avoid
wearing the hearing aid. Being the
intellectual that he was, my father analysed his hearing situation. He said
that even after he got used to the machine in his ears, another problem
prevailed. He saw that people tend to
shout at the elderly to make them hear better.
However, though he heard less, and wore a state-of-the-art hearing aid, he
said his real problem was not the lack of volume. He felt that the connections
that a person makes between words, which enable them to make sense of a
sentence, and which is like second nature for a younger person, had slowed down
for him with age. Therefore, when someone said something to him, while he was
struggling to connect the first word to the second, the speaker had finished
entire sentence. Hence, it was difficult for him to instantaneously piece
together what the speaker was saying. Even
a two second time lag made a difference in comprehending the sentence in its entirety.
The speaker, however thinks it is because of lack of hearing and says the same
thing, perhaps with different words in a louder voice. Whenever someone spoke
slowly and distinctly to him, he said he had no problem. This was a great insight, something that
people with non-ageing brains do not experience and hence cannot understand. And
because we do not understand, we get very impatient when trying to communicate
with the elderly.

Another sense that
goes with age is taste. We often disregard this as it is not as visible to us. The
idea of not being able to taste well does not usually occur to us, because it
is so beyond our experience. Most of us
cannot even imagine a situation of
tastelessness. Many older people complain about their food being insipid ---
we interpret that as fussiness and wanting to get attention, rather than an
age-related physical debility. My father had analysed this debility very early
on. Towards the last three-four years of his life, the only taste he could get
was sweet. Hence, everything he ate during those year had to have Sugarfree on
it to make it appetising. He was a diabetic for more than 50 years, and had
managed his diabetes in an exemplary manner --- he was very adept at avoiding
any bit of sugar in anything that he ate for half a century! If there was sugar
even in something savoury, like a curry, he could detect it immediately! He felt that perhaps his taste for sweetness
survived other tastes because those taste buds had hardly been used for more
than half his life. Thankfully, it was
this previously unused taste that made his food palatable now.

One of the
conversations Dr Gawande had with Dr Felix Silverstone was
while they were eating dinner at the restaurant-like formal dining room at the
retirement community that Felix and his wife lived in. Felix’s wife had lost her vision with age; her husband had to first
cut up her food into bite size pieces, then guide her hand, explaining where
each item was, so that she could eat. While
they were eating, she choked on her food, and Felix told her to go slow,
chewing each bite well. Felix told Gawande that as a person gets older, lordosis
of the spine tips the person’s head forward.
This makes swallowing difficult and choking on one’s food very common. During the course of the dinner, Gawande could
hear someone choking on their meal every minute or so. Soon after, Dr Felix
Silverstone himself choked. He started coughing, and turned red. Finally, he
was able to cough up the bite. It took a minute for him to catch his breath.
“Didn’t follow my own advice,” he said. Again,
being able to swallow each bite is something we take for granted, while for the
elderly, this mundane task may even become life threatening.

When food becomes
unpalatable and the process of eating becomes prone to choking, many elderly
cut down on its intake. Added to this are factors like a sluggish stomach,
gastrointestinal issues and other diminished functions which lead to problems
of incontinence, constipation, abdominal discomfort and other things. For most of us, just
one of these problems would be enough to make us distressed, embarrassed, anxious
and uneasy. And in the elderly, a whole lot of these problems come together,
along with things like weak knees, aching bones, and so on!

As I studied the
aged in my family and in my acquaintances’ families, what I realized was that
though medical science has made leaps in prolonging life and well-being of the
physical body, it has not been able to do much about the ageing mind. Perhaps
because medical science does not see it as a priority. In his book, Gawande
says that Dr Felix Silverstone was able to manage the physical disabilities
fairly well. He switched to an electronic stethoscope to counteract his hearing
loss, he took measures to keep himself healthy and fit. He was however,

most concerned about the changes in his
brain. “I can’t think as clearly as I used to”, he said. “I used to be able to
read the New York Times in half an hour. Now it takes me an hour and a half”. Even then, he wasn’t sure that he understood
as much as he did before, and his memory gave him trouble. “if I go back and look at what I have read, I
recognize that I went through it, but sometimes, I don’t really remember it,”
he said. “It is a matter of short term registration. It’s hard to get the
signal in and have it stay put.” (Atul Gawande, in Being Mortal).

My father could
relate very well to this. He was a voracious reader. He was a person who always
had a book by his side. He too felt his concentration decreasing with age.
During the last few years, he re-organized his reading --- he did most of his
heavy philosophical reading and writing in the morning, when his concentration
was the highest. Later in the day, he
read lighter material, as well as watched television. Watching television too, however was not
easy. Hearing and a loss in instant
registration made comprehension a little sluggish. But I heard him, and several other seniors
say that while watching the news, the news ticker, where the headlines are repeatedly
scrolled across the bottom of the screen is a useful tool to make sense of what
is going on in the world.

I am only touching
the tip of the iceberg here as to what happens when a person ages. A point that Gawande makes has stayed in my
mind. He said that several very old
people have told him that it is not death they fear. It is what happens before
death --- losing their memory, their best friends, their way of life. Felix
Silverstone put it to him as “Old age is a continuous series of losses”.

This post was predominantly
about this --- how do we reach out to those among us who may at this point be
losing some of their shine and lustre; who may be feeling an immense sense of
loss. Perhaps it is this sense of loss that is there behind their silences,
their crankiness or their apathy towards things around them. How do we help them cope with this final
stage in their lives, when they need us the most? Most of the time, we are unable
to even comprehend what is going on in their minds, as it is so alien to us who
are much younger. A lot of times, we
have the image of the person in their prime, and do not realize the changes that
age has perhaps brought about on their minds and bodies.

Why have I written
this post on a blog on Critical Thinking? Because a key component of critical thinking
is being able to change lenses and see something from someone else’s perspective.
I am sure many of my readers have an elderly in their midst. By looking at
their realities through their eyes
may make our interactions easier and enable us to make their evening years
better.

Critical Thinking
is also about questioning our own actions and ideas. I know it is not always
possible for a younger person to empathize about what the very old are grappling
with. But most of the time, we do not even realize that age may bring in changes, and that the elderly may themselves be
struggling to make sense of these changes.
This is what this post asks us to do, to question ourselves --- are
we by any chance forgetting that they are no longer in their prime? Are we perhaps
overlooking the changes that their minds and bodies are going through?

Please feel free
to continue this conversation and respond with your own experiences.

You have analysed the whole story of the elderly ones perfectly --we at times become totally helpless with them a but only if could understand their part of the story and handle them like small babies life would be truly comfortable for them.It's patience and care that they require along with the necessary medical help.

That's v.True .Recently I experienced all that u have written practically with my mom --who was having multiple problems--like knee aches, hard of hearing etc.I had to balance many a times --lost patience to at times but at the end used my patience and explained to her just as she did wen I was small.Then I realised that now I have to be her guardian angel.